医療機関による医薬品の処方に際しては、被保険者（患者）が保健医療機関で医師の診察を受け、その診断結果をもとに医師が処方箋を発行、同処方箋に基づき保険薬局にて医薬品が調剤、提供される、という流れになっている。保険が適用される医薬品の費用請求については、被保険者による一部費用負担を除くと、医療機関・保険薬局などが、レセプトと呼ばれる診療報酬明細書に、診療、検査、投薬、手術など医療行為の内容を記入し、月ごとに審査支払機関に提出、医療費を請求する。審査は、社会保険診療報酬支払基金と都道府県支部、国民健康保険中央会と各都道府県の国民健康保険団体連合会にて実施され、かかった医療費をそのまま医療保険から支払う「出来高払い制」を採用されている。
Actions Pharmacology - How the drug performs in your body to elicit a response Pharmacokinetics/Dynamics - The magnitude of a drug's effect is determined by the drug concentration at the website of action. The pharmacodynamics are expressed when it comes to onset of motion and period of action. Pharmacokinetics are expressed with regards to absorption, distribution (which includes physical appearance in breast milk and crossing in the placenta), protein binding, metabolism, half-everyday living distribution, time for you to peak, and excretion.
Once the inquiry in the professional medical institution, the final prescription content is transmitted through the medical institution on the information procedure when the prescription drug is set. When an insurance coverage pharmacy inquires about The supply of insurance plan for prescription drugs explained in prescriptions, the existence / absence of the inquiry background Together with the professional medical establishment and the effects are dispersed. At last, a number of inquiry histories is dispersed on the evaluation and payment institution and also the insurer, along with the information inquiry / judgment technique is done.
指定条件を満たしていると判定した場合には、次に、医療機関・保険者の住所から近くに存在する複数の保険薬局に対して、処方対象医薬品の取扱状況・在庫状況を確認、結果をあわせて医療機関へ配信する。一方、指定条件を満たしていないと判定した場合には、審査支払機関及び保険者の指定条件に合致する範囲内で医療機関が提示した被保険者情報をもとに導出される処方推奨対象となる医薬品のリストを医療機関に配信、医療機関にて再選択を促す。医療機関にて処方推奨医薬品が選択されると、近隣の保険薬局での取扱状況・在庫状況を確認、結果を通知する。
結果として、医療サービス受給の公平性を保ちつつ、代替品が存在する医薬品の中で、被保険者・保険者や審査支払機関が、効果・価格等の観点から望ましいと考える医薬品を選択する機会が十分に提供されていない。
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【選択図】図３[Difficulties] To deliver a technique for providing an opportunity for your healthcare institution / coverage pharmacy to preferentially adopt a medicine that an insured / insurer or examination / payment institution desires to prescribe inside the professional medical insurance policy technique. Furnished. [Usually means FOR Resolving Complications] Moving into / Keeping information on alternate options, prescription priority order information of an insurance provider, and ailments / specifications for approval of the receipt assessment by an evaluation / payment establishment for your medicine prescribed by an insurance plan health-related institution Inquiries concerning no matter if coverage for prescription drugs is available for Each individual medical exercise within the suggests and health-related establishment, and if the inquiries match the required problems from the insurance company / assessment and payment Business according to personal information including signs of your insured Implies to find out whether the above mentioned inquiry content will not match the desired problems, search for other drugs that meet the specified situations through the drugs specified because of the insurance provider based upon the insured's information such as signs A program obtaining signifies for notifying a health care institution as an alternative and prompting the medical establishment to reselect prescription contents. [Variety] Figure three Description
The professional medical prescription information inquiry / distribution technique Based on declare one, whereby the health care prescription is acquired from the clinical establishment for each health-related exercise, and insured information (health care insurance connected information, injuries and ailment) introduced within the medical establishment at some time of inquiry.
) presented through the health care institution at the time of inquiry and information obtained beforehand And in genuine-time if the required problems in the insurer to whom the insured is affiliated and the evaluation and payment Firm in charge are glad.
How many times Have you ever still left the health practitioner’s Place of work, only to seek out you forgot to say an important bit of information?
The present invention for resolving the above-described issues is composed of the subsequent components. (1) Enter and keep information on substitutes and prescription precedence information of insurers for pharmaceuticals prescribed by insurance plan healthcare institutions for insured folks (2) Enter and sustain the ailments and criteria for receipt evaluation approval with the evaluation and payment Group (three) Accepting inquiries from professional medical establishments concerning the availability of insurance policy for prescription drugs for each health-related apply, and producing inquiries depending on personalized information like the insured's signs, medical background, age, and so on., and information on (one) and (2) over Judgment is designed in serious time to find out whether the content get more info fulfills the circumstances specified because of the insurance company / evaluation and payment establishment (4) If the above inquiries will not meet up with the specified disorders, try to find other drugs that meet up with the specified disorders dependant on the insured's information including symptoms, and many others. Notify health-related establishments and inspire them to reselect prescription information.
Drug Research by Disease/Symptom - Figure out what a drug is useful for, or if an adverse reaction could possibly be because of a certain drug.
An example of the configuration of this kind of an information process is revealed in FIG. In this instance of information system, a minimum of Display screen and output device / input unit / info storage for instance everyday notebook computer with interaction indicates set up in each of examination paying institution, insurance provider, insurance policies medical establishment, insurance policy pharmacy And a central method that performs information inquiry / perseverance are connected by means of a communication line like the net.
Really should your professional medical physician requirements the pharmacist to provide you with a particular brand of medication, they've to exactly Observe this or register the House delivered.